1 Selective serotonin reuptake inhibitors (SSRI) – sales, withdrawal ...

general, a motivated GP in an urban setting (where the rate of depression is 20%) would correctly
diagnose ten out of 20 cases, missing ten true positives. The GP would correctly reassure 65 out of
80 non-depressed individuals, falsely diagnosing 15 people as depressed” (45). Thus there is both
an under- and an over-diagnosing problem, and according to Mitchell´s conclusion false positives
contribute considerably to the increased treatment rate (45).
It is plausible that some of the psychotropic treatment has been changed from the benzodiazepines
to the SSRIs, as some of the indications are the same. There is, however no evidence for this. A
study by Berney et al (46) concluded that the change of the prescribing pattern from
benzodiazepines to newer antidepressants was not based on evidence with a high level of proof,
since there is only one double-blind, randomized controlled trial comparing one of these
antidepressants to a benzodiazepine, among 274 double-blind, randomized trials on drug efficacy in
panic disorder, generalized anxiety, social phobia and post-traumatic stress disorder.
Discussion
Two books have been published in 2010, both of them trying to explain or understand why
diagnosed depression has increased so rapidly over the last 60 years. In the first book Alain
Ehrenberg (47) sees a depression epidemic in the modern society as a real phenomenon. The
individual in the modern society shall perform and unfold itself and this demand of self-realisation
is followed by a responsibility for the individual´s own success and happiness. The good message,
according to Ehrenberg, is that doctors today are able to offer a diagnosis and a treatment,
antidepressants, and the modern human being can get relief, when unable to fulfil the demands of
success and happiness.
In the second book Gary Greenberg (48) offers another explanation of the epidemic of depression.
The introduction of the new antidepressants, SSRI, with fewer adverse effects than the older
antidepressants, played together with the new diagnostic tools in the DSM-IV, with which general
practitioners were able to diagnose more patients as depressive than before. Also the way people
were talking about depression changed, because of a new theory that depression was caused by a
biochemical imbalance in the brain with lack of serotonine, which could be cured with the new
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